“There’s Nothing Wrong With You”: Pain-Related Stigma in Adolescents With Chronic Pain, 2021, Wakefield et al

Abstract
Objective
Adolescents with chronic pain often experience symptom disbelief and social rejection by others secondary to “medically unexplained” symptoms. Although chronic pain is common in adolescents, limited research has conceptualized these social experiences as pain-related stigma in this population. The purpose of this study was to identify and describe pain-related stigma among adolescents with chronic pain and their parents using focus group methodology.

Methods
Five adolescent focus groups (N = 18; Age M = 15.33 years, SD = 1.28) and three parent focus groups (N = 9) were conducted. Directed content analysis was used to analyze focus group transcripts. Stigma categories were developed a priori (Felt Stigma, Anticipated Stigma, Internalized Stigma, Concealment, and Controllability) and new categories emerged during analysis. Two coders reached 87.16% agreement for all groups (adolescent group: 90.34%; Parent group: 79.55%) and consensus was achieved for discordant codes.

Results
Adolescents and their parents endorsed pain-related stigma across all social domains. Analyses revealed four main categories for both groups (a) Felt Stigma (subcategories: pain dismissal, faking or exaggerating, and mental health stigma), (b) Anticipated Stigma and Concealment, (c) Internalized Stigma, and (d) Sources of Pain-Related Stigma (subcategories: pain invisibility, lack of chronic pain knowledge, lack of understanding, and controllability).

Conclusions
Adolescents with chronic pain experience pain-related stigma from medical providers, school personnel, family members, and peers, which may have negative social and health implications. More research is needed to evaluate the link between pain-related stigma and health outcomes for adolescents with chronic pain. Clinical approaches targeting pain-related stigma are discussed.

Open access, https://academic.oup.com/jpepsy/advance-article/doi/10.1093/jpepsy/jsab122/6454082

 

Unm. How does this fit with the Secondary Gains? Anyway possible connection do we think?

 

You are not trying hard enough with the circular logic. Stigma is the secondary gain. People looking down on you and not believing you means you are the centre of their attention, even if they avoid you and you never see them.

This is the wonder of a BPS approach that enables you to continuously shift the goal posts, so that even contradictory evidence becomes proof of your approach.

 

Of course!
I knew I overlooked something.

They inflict pain. We tell them to stop. They tell us they won’t, they say they know we like it.

We tell them we don’t like it, we want them to stop. They tell us that when we say that it meant that we are masochists, even if we lack awareness that that is what we are. That pain is what we need. That they will provide it. No matter how many times we say no to them.

They seem to like work with children or teenagers best. Perhaps they are the easiest to ‘teach’.

 

as a teenager i fell about six feet out of a tree sprained my fore arm quite badly parent insisted on seeing gp . back then it was turn up at practice and wait so after 90 minutes goes into gp he looks and says it is growing pains . this was the first time i became disillusioned with so called medical professionals . at school sent to the nurse she listened to the exact same thing i told the doctor guess what she agreed with me that i had strained the muscles in my fore arm . i wonder what amount of information from gp practices is factually correct or just the befuddled opinion of overworked and exhausted gps .

 

How much is misdiagnosis? Or a lack.of investigation?

My friends daughter had ongoing back pain blamed on heavy schoolbag .
This went on for 12 months. 2 physios failed to make much impact. She could not sit long enough to do any more than 40mins at a time. School were verging on school phobia - anxiety was setting in.

There was clearly something visibly wrong with her back ( perhaps not as visible earlier) which was picked up by a locum gp after exasperated mum pronounced that she could see something wrong - why wasn't it being picked up?

Scoliosis. Tens machine helps.